# EVERGREEN AT MISSOULA, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES MONTANA HEALTHCARE, LLC
- **Other names:** Missoula Health and Rehabilitation Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1538117940
- **Legal business name:** EMPRES MONTANA HEALTHCARE, LLC
- **Authorized official:** MICHAEL J. MILLER (CFO AND ASSISTANT MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 3018 RATTLESNAKE DR, MISSOULA, MT 59802-6101
- **Practice address phone:** (406) 549-0988
- **Practice address fax:** (406) 549-0111
- **Mailing address:** 4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6736
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | MT | — |
| 310400000X | Assisted Living Facility | — | MT | — |
| 314000000X | Skilled Nursing Facility | 7280 | MT | — |
| 314000000X | Skilled Nursing Facility | — | MT | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 01/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0310029 | — | MT |